U.S. needs national health care, not health insurance

When one has an accident or comes down with a serious illness, should the first question be: “Do you have insurance? Does it cover this?” Uncertainty or worry can make one hesitate to take preventive measures just to save expenses. A young American friend, a professor in Canada, recently visited and said it was so nice not to have to worry about costs when she was diagnosed with cancer.

Insurance spreads with other people the costs involved for certain risks. Thus insurance companies limit the obligations and liabilities to be covered. Auto or fire or business insurance make sense. I was very grateful for insurance replacing our roof after hail damage.

But health insurance poses a problem because it does not and cannot control all the risks that may arise. Catastrophic illness or injury, which may come to anyone rich or poor, imposes obligations on a company which it might not have anticipated or been able to underwrite. Any insurance company must operate as a business within reasonable or possible resources. Insurance has a role where risks are more clearly identified and indemnified. Insurance is hardly the model for health.

Many advocate requiring everyone carry health insurance. A subsidy could pay for those unable to afford coverage. Who then will pay for those who cannot buy health insurance? Failure of some people to have health insurance has driven greater numbers to use emergency rooms. This is great, but who pays for these facilities and staff? The hospital or the “government” (namely, us)?

The idea of risk with health is different from that in auto or house or business insurance. The individual can be prudent and have a role in maintaining good health, but cancer, coughs, appendicitis, curvature of the spine, arthritis, mental illness, etc., impose themselves without regard to statistics. Early detection, care or prevention saves money. Every newborn (and mother) deserves pre- and post-natal care. We all benefit from healthy citizens. They work, pay taxes, make for good life.

Many industries, medical associations, unions and many in the public are calling for a national health care system. Industry wanted health coverage because it made its workers more dependable and it was a positive inducement for employment. But now health insurance is a disadvantage with many foreign countries.

Critics of a national health care system raise several points. 1) We want to choose our own doctors and hospitals. In reality some insurance executives determine which resources we may access. We really don’t have completely free access now. A good plan would require some primary point for coordinating information and authorization.

2) Many contend that people in other countries have to wait and wait for help. We must admit that many times we schedule appointments for a time in the future. My next surgery was scheduled for six weeks in the future. Many are the stories of having to wait even with our insurance system.

3) Quality in other countries is inferior. Can we assume the various national health care programs would intend to diminish quality? Our standards for medical care must not be compromised.

4) Cost. How many trillion dollars will it take? We know that Americans pay more per person for the care we receive compared to other countries. We spend $1 out of every $6 for health care. Also, many reports claim up to 30 percent of health care costs are absorbed by nonmedical services, such as paperwork, records and reports to insurance or Medicare and Medicaid, and executive salaries.

My expenditures for health care come to thousands of dollars — and we have been relatively very healthy. If one expects increases in taxes for health care, there will be some offset for what we are now paying through other avenues.

I believe we have the knowledge and ability to devise a national health care system for all people to cost less than the present, a system better than we have today and better than even our Canadian neighbors have.

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Comments

Excellent discussion. Universal healthcare should be an accepted part of the social contract. It should not be set up as a for-profit business that gambles on health risks.

We pay taxes for good roads, good schools, good police and fire departments, why not good healthcare? It's a no brainer that for-profit health insurers will continue to practice rescission (see below) and cut people off when they actually have expensive health issues. Affordability has to be based on universal coverage with NO PROFIT motive.

In testimony to Congress, three CEOs of major health insurance companies refused to consider limiting the practice of rescission to cases of policyholders who intentionally lie or commit fraud:

"An investigation by the House Subcommittee on Oversight and Investigations showed that health insurers WellPoint Inc., UnitedHealth Group and Assurant Inc. canceled the coverage of more than 20,000 people, allowing the companies to avoid paying more than $300 million in medical claims over a five-year period.

It also found that policyholders with breast cancer, lymphoma and more than 1,000 other conditions were targeted for rescission and that employees were praised in performance reviews for terminating the policies of customers with expensive illnesses." LA Times, "Health insurers refuse to limit rescission of coverage"

"But rescission victims testified that their policies were canceled for inadvertent omissions or honest mistakes about medical history on their applications. Rescission, they said, was about improving corporate profits rather than rooting out fraud. ...

A Texas nurse said she lost her coverage, after she was diagnosed with aggressive breast cancer, for failing to disclose a visit to a dermatologist for acne.

The sister of an Illinois man who died of lymphoma said his policy was rescinded for the failure to report a possible aneurysm and gallstones that his physician noted in his chart but did not discuss with him.

The committee's investigation found that WellPoint's Blue Cross targeted individuals with more than 1,400 conditions, including breast cancer, lymphoma, pregnancy and high blood pressure. And the committee obtained documents that showed Blue Cross supervisors praised employees in performance reviews for rescinding policies.

One employee, for instance, received a perfect 5 for "exceptional performance" on an evaluation that noted the employee's role in dropping thousands of policyholders and avoiding nearly $10 million worth of medical care.

Committee members took turns, alternating Democrats and Republicans, condemning such practices." (from LA Times article cited in previous post)

Committee members took turns condemning such practices, but the Republicans and "moderate" Dems still plan to derail a public plan which would force health insurance companies to compete with a non-profit alternative.